Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2002 Apr;56(4):301–308. doi: 10.1136/jech.56.4.301

Comparing hospital discharge records with death certificates: Can the differences be explained?

L Johansson 1, R Westerling 1
PMCID: PMC1732113  PMID: 11896139

Abstract

Study objective: The quality of mortality statistics is important for epidemiological research. Considerable discrepancies have been reported between death certificates and corresponding hospital discharge records. This study examines whether differences between the death certificate's underlying cause of death and the main condition from the final hospital discharge record can be explained by differences in ICD selection procedures. The authors also discuss the implications of unexplained differences for mortality data quality.

Design: Using ACME, a standard software for the selection of underlying cause of death, the compatibility between the underlying cause of death and the final main condition was examined. The study also investigates whether data available in the hospital discharge record, but not reported on the death certificate, influence the selection of the underlying cause of death.

Setting: Swedish death certificates for 1995 were linked to the national hospital discharge register. The resulting database comprised 69 818 people who had been hospitalised during their final year of life.

Main results: The underlying cause of death and the main condition differed at Basic Tabulation List level in 54% of the deaths. One third of the differences could not be explained by ICD selection procedures. Adding hospital discharge data changed the underlying cause in 11% of deaths. For some causes of death, including medical misadventures and accidental falls, the effect was substantial.

Conclusion: Most differences between underlying cause of death and final main condition can be explained by differences in ICD selection procedures. Further research is needed to investigate whether unexplained differences indicate lower data quality.

Full Text

The Full Text of this article is available as a PDF (174.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barach P., Small S. D. Reporting and preventing medical mishaps: lessons from non-medical near miss reporting systems. BMJ. 2000 Mar 18;320(7237):759–763. doi: 10.1136/bmj.320.7237.759. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Calder S. J., Anderson G. H., Gregg P. J. Certification of cause of death in patients dying soon after proximal femoral fracture. BMJ. 1996 Jun 15;312(7045):1515–1515. doi: 10.1136/bmj.312.7045.1515. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Chow W. H., Devesa S. S. Underreporting and misclassification of urinary tract cancer cases on death certificates. Epidemiology. 1996 Sep;7(5):517–520. [PubMed] [Google Scholar]
  4. D'Amico M., Agozzino E., Biagino A., Simonetti A., Marinelli P. Ill-defined and multiple causes on death certificates--a study of misclassification in mortality statistics. Eur J Epidemiol. 1999 Feb;15(2):141–148. doi: 10.1023/a:1007570405888. [DOI] [PubMed] [Google Scholar]
  5. Donaldson L. J., Parsons L., Cook A. J. Death certification in fractured neck of femur. Public Health. 1989 Jul;103(4):237–243. doi: 10.1016/s0033-3506(89)80036-8. [DOI] [PubMed] [Google Scholar]
  6. Ewigman B., Kivlahan C., Land G. The Missouri child fatality study: underreporting of maltreatment fatalities among children younger than five years of age, 1983 through 1986. Pediatrics. 1993 Feb;91(2):330–337. [PubMed] [Google Scholar]
  7. Gittelsohn A., Senning J. Studies on the reliability of vital and health records: I. Comparison of cause of death and hospital record diagnoses. Am J Public Health. 1979 Jul;69(7):680–689. doi: 10.2105/ajph.69.7.680. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Goldacre M. J. Cause-specific mortality: understanding uncertain tips of the disease iceberg. J Epidemiol Community Health. 1993 Dec;47(6):491–496. doi: 10.1136/jech.47.6.491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hamvas A., Kwong P., DeBaun M., Schramm W., Cole F. S. Hyaline membrane disease is underreported in a linked birth-infant death certificate database. Am J Public Health. 1998 Sep;88(9):1387–1389. doi: 10.2105/ajph.88.9.1387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Jansson B., Johansson L. A., Rosén M., Svanström L. National adaptations of the ICD rules for classification--a problem in the evaluation of cause-of-death trends. J Clin Epidemiol. 1997 Apr;50(4):367–375. doi: 10.1016/s0895-4356(96)00426-x. [DOI] [PubMed] [Google Scholar]
  11. Johansson L. A., Westerling R. Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics. Int J Epidemiol. 2000 Jun;29(3):495–502. [PubMed] [Google Scholar]
  12. Jougla E., Papoz L., Balkau B., Maguin P., Hatton F. Death certificate coding practices related to diabetes in European countries--the 'EURODIAB Subarea C' Study. Int J Epidemiol. 1992 Apr;21(2):343–351. doi: 10.1093/ije/21.2.343. [DOI] [PubMed] [Google Scholar]
  13. Kelson M., Farebrother M. The effect of inaccuracies in death certification and coding practices in the European Economic Community (EEC) on international cancer mortality statistics. Int J Epidemiol. 1987 Sep;16(3):411–414. doi: 10.1093/ije/16.3.411. [DOI] [PubMed] [Google Scholar]
  14. Maudsley G., Williams E. M. "Inaccuracy' in death certification--where are we now? J Public Health Med. 1996 Mar;18(1):59–66. doi: 10.1093/oxfordjournals.pubmed.a024463. [DOI] [PubMed] [Google Scholar]
  15. McAnulty J. M., Rubin G. L., Rushworth R. L., Kaldor J. Underreporting of AIDS, New South Wales, 1988-1989. Med J Aust. 1992 Apr 6;156(7):452–455. doi: 10.5694/j.1326-5377.1992.tb126469.x. [DOI] [PubMed] [Google Scholar]
  16. Moriyama I. M. Problems in measurement of accuracy of cause-of-death statistics. Am J Public Health. 1989 Oct;79(10):1349–1350. doi: 10.2105/ajph.79.10.1349. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Nilsson A. C., Spetz C. L., Carsjö K., Nightingale R., Smedby B. Slutenvårdsregistrets tillförlitlighet. Diagnosuppgifterna bättre än sitt rykte. Lakartidningen. 1994 Feb 16;91(7):598, 603-5. [PubMed] [Google Scholar]
  18. Pietro D. A., Shyavitz L. J., Smith R. A., Auerbach B. S. Detecting and reporting medical errors: why the dilemma? BMJ. 2000 Mar 18;320(7237):794–796. doi: 10.1136/bmj.320.7237.794. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Pollock D. A., Boyle C. A., DeStefano F., Moyer L. A., Kirk M. L. Underreporting of alcohol-related mortality on death certificates of young US Army veterans. JAMA. 1987 Jul 17;258(3):345–348. [PubMed] [Google Scholar]
  20. Saracci R. Problems with the use of autopsy results as a yardstick in medical audit and epidemiology. Qual Assur Health Care. 1993 Dec;5(4):339–344. doi: 10.1093/intqhc/5.4.339. [DOI] [PubMed] [Google Scholar]
  21. Schuitemaker N., Van Roosmalen J., Dekker G., Van Dongen P., Van Geijn H., Gravenhorst J. B. Underreporting of maternal mortality in The Netherlands. Obstet Gynecol. 1997 Jul;90(1):78–82. doi: 10.1016/S0029-7844(97)00128-2. [DOI] [PubMed] [Google Scholar]
  22. Stegmayr B., Asplund K. Measuring stroke in the population: quality of routine statistics in comparison with a population-based stroke registry. Neuroepidemiology. 1992;11(4-6):204–213. doi: 10.1159/000110933. [DOI] [PubMed] [Google Scholar]
  23. Whittall D. E., Glatthaar C., Knuiman M. W., Welborn T. A. Deaths from diabetes are under-reported in national mortality statistics. Med J Aust. 1990 Jun 4;152(11):598–600. doi: 10.5694/j.1326-5377.1990.tb125391.x. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES